Provider Demographics
NPI:1285181792
Name:BAKER, BRYAN (DPT)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 20TH ST NW STE 116
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3406
Mailing Address - Country:US
Mailing Address - Phone:202-416-2110
Mailing Address - Fax:202-416-2011
Practice Address - Street 1:1120 20TH ST NW STE 116
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3406
Practice Address - Country:US
Practice Address - Phone:202-416-2110
Practice Address - Fax:202-416-2011
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT210002137225100000X
TX1347405225100000X
MAPTL22588225100000X
CT11503225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist